New Client Application – Valuation

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Company Name:

PRINCIPAL OF BUSINESS NAME

Principal of Business Name:

First Last

Principal of Business Title:

Primary Phone

Fax

Mobile

Email

SECONDARY CONTACT NAME

Secondary Contact Name

First Last

Secondary Contact Title

Primary Phone

Email

Mobile

Address

Street Address Address Line 2 City State ZIP Code

Website

How many Business Owners are there?

Is any ownership held in a Living or Revocable Trust?

Reason for Valuation

What percentage of Ownership is to be valued?

As of Date for Valuation

Is there a accessible secondary market to sell ownership interest?

Date of Incorporation/Formation

State Where Incorporated

Most Recent Fiscal Year End

Form of Organization - What is your legal business entity type?

What Federal Tax Return does your business file?

Do you have a written business plan?

Annual Sales for the last 3 years

1st year

2nd year

3rd year

Net Income for the last 3 years

1st year

2nd year

3rd year

Number of Employees

Industry

Does the company own any subsidiary organizations?

Does any other company own an interest in this business?

Write a brief History of the Business?

What growth plans do you have?

What are your competitive advantages and disadvantages?

Who are your top 5 competitors?

Competitor 1

Competitor 2

Competitor 3

Competitor 4

Competitor 5

What barriers exist for new competitors?

Do you do any forecasting or long-term budgeting?

Do you expect future capital needs or new financing?

Are you concerned about any of your asset, liability, or income statement accounts to which we should pay particularly close attention?

Do you have a Retirement Plan?

Do you prepare your own payroll?

Number of Bank Accounts

Number of Lines of Credit

Number of Credit Card Accounts

Number of Other Loans

ACCOUNTING FIRM CONTACT

Who is your Accounting firm?

Accountant

First Last

Contact Title

Primary Phone

Email

FINANCIAL ADVISOR CONTACT

Who is your Financial Advisor?

Financial Advisor Name

First Last

Position Title

Primary Phone

Email

ATTORNEY CONTACT

Who is your attorney?

Attorney Contact Name

First Last

Contact Title

Primary Phone

Email

Do you have a current will?

Have you established an Estate Plan?

Have you established a Trust?

Referred By (Optional)

Prospective Client Application – Valuation

PRINCIPAL OF BUSINESS NAME

SECONDARY CONTACT NAME

ACCOUNTING FIRM CONTACT

FINANCIAL ADVISOR CONTACT

ATTORNEY CONTACT